ON MENTAL ILLNESS: The Factors That Govern a Good Outcome

Jack Bragen
Thursday July 17, 2014 - 11:33:00 AM

The main concerns that govern how well someone with mental illness will do, include, but are not limited to, treatment, housing, relationships and employment. 

Good housing is a major concern of someone whose mental illness is disabling to the extent that it affects work. If someone does not have or can not maintain skilled, full-time employment, it is very difficult to obtain decent housing. For good housing, money is usually required. It determines whether or not someone is living in safety and comfort, versus someone who must live in life threatening circumstances and slum-like conditions. There also exists the "board and care" option in which a person with mental illness lives in shared housing without any privacy to speak of, and with very few personal belongings. However not all persons with mental illness require supervised housing. 

The number of affordable housing units in the Bay Area is dwindling. It is becoming harder and harder to find a place, even if you have a section 8 certificate in good standing. Thus, even those of us who do not require supervision at all times, and are capable of supervising ourselves, can find it very hard to locate an affordable unit. 

Housing can make the difference between a mentally ill person struggling to survive plus being continually re-traumatized, versus making continued progress in recovery. The threat of violence is a form of violence. Thus, if you are being threatened, then in effect you are being assaulted. 

One's housing should be a source of comfort, a source of pride, and a refuge where one can retreat when realities are a bit harsh. It should not be a source of stress, a source of terror, or a source of uncertainty. 

Treatment of one's illness is more important than housing, but not by a big margin. If the condition is not being treated, then you don't have a usable mind. Without a usable mind you can not accomplish anything. The realization that you need treatment comes not when one is forced into treatment, but rather when a person understands the cause and effect relationship of medication used to treat mental illness. With force comes resentment. And it prevents the learning curve from taking shape in which someone with mental illness eventually learns from his or her mistakes. 

Treatment, on the other hand, is what brings some amount of clarity. Thus, when fully psychotic, manic or depressed, the learning mechanism is not intact. 

It would be simplistic of me to say forcing medication on someone is never necessary. And it would also be simplistic to say there is no factual basis for modern psychiatry. Mental illnesses are complex diseases that bring forth complex issues. At any given time, someone will be displeased with how things are. 

On the other hand, the basic human dignity and human rights of people with mental illnesses are oft trampled upon by overzealous treatment practitioners or by bad police practices. Thus, when bringing treatment to a person with mental illness against their express wishes or otherwise, the how of what gets done is as important as what gets done. 

Mental health treatment practitioners and police who deal with mentally ill people must be accountable. As it stands now, they are in fact getting away with murder some of the time. This happens to people who are mishandled in the name of cleaning up a nuisance on the streets. It happens when lethal force is used by a police officer when it is not needed. It happens to people who are put into restraints and it triggers asphyxiation, heart attack or stroke. It happens when people die young of the metabolic side-effects of medication. 

Notwithstanding all of this, treatment is a basic necessity for someone with mental illness. 

The importance of relationships is right up there with that of housing and treatment. I am not referring to romantic partnerships, but to anything in which there is an emotional bond. Thus, members of one's immediate family play an extremely important role in the recovery of someone with mental illness. Relationships with family or with someone you call a friend, can some of the time prevent suicide—that's the magnitude of their importance. Relationships allow someone to connect with the rest of the world, and not live in an isolated, pseudo reality. 

When I listed employment, it is used very loosely. For purposes of this article, "employment" refers to any meaningful or gainful activity performed on a regular basis. This can include volunteer work, it could include painting pictures or sculpting, it could include babysitting or raising offspring. The point is that you are doing something more with your life than the bare minimum. And doing that creates hope and a positive outlook. Yet, my suggestion of "employment" is optional and need not be used as a standard against which to judge yourself as insufficient. 

What I haven't mentioned above is that you should consider yourself a good person, worthy of self-respect, no matter what anyone says and regardless of what you have or have not accomplished.